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Obstructive sleep apnea (OSA) is associated with impaired glycemic control and a higher risk of vascular complications, such as diabetic kidney disease (DKD). However, the effect of apnea-hypopneas suppression on DKD progression is unclear.To assess the effect of continuous positive airway pressure (CPAP) on urinary albumin-to-creatinine ratio (UACR) in patients with DKD and OSA.In a 52-weeks, multicentric, open-label, parallel, and randomized clinical trial, 185 patients with OSA and DKD were randomized to CPAP and usual care (n=93) or usual care alone (n=92).UACR, estimated glomerular filtration rate (eGFR), serum levels of creatinine and glycated hemoglobin, insulin resistance, lipid levels, sleepiness and quality of life. 52-week change in UACR from baseline did not differ significantly between the CPAP group and the usual-care group. However, in per-protocol analyses, which included 125 participants who met prespecified criteria for adherence, CPAP treatment was associated with a great reduction in UACR (mean difference, -10.56% [95% confidence interval {CI}, -19.06 to -2.06]; p=0.015). CPAP effect on UACR was higher in non-sleepy patients with more severe OSA, worse renal function and more recent diagnosis of DKD. CPAP treatment also improved glycemic control and insulin resistance, as well as sleepiness and health-related quality of life.In patients with OSA and DKD, the prescription of CPAP did not result in a statistically significant reduction in the albuminuria. However, good adherence to CPAP treatment in addition to usual care may result in long-term albuminuria reduction compared to usual care alone. Clinical trial registration available at www.gov, ID: NCT02816762.

BACKGROUND AND AIMS The clinical effectiveness of COVID-19 vaccination in kidney transplant (KT) recipients is lower than in the general population. However, the evidence reported is limited so far. Our purpose is to analyze the characteristics and outcomes of a large series of KT with COVID-19 breakthrough infection and compare them with unvaccinated patients. As a secondary objective, we analyzed the evolution according to the type of mRNA vaccine administered. METHOD From April to October 2021, KT recipients with COVID-19, included in the Spanish Society of Nephrology COVID-19 Registry, were analyzed. Data regarding vaccination status and type of vaccine were collected and outcomes of unvaccinated patients were compared with fully vaccinated patients. Univariable and multivariable Cox proportional hazard regression analyses were assessed for independent risk factors of COVID-19-related death. To avoid bias as much as possible, a sensitivity analysis was done exclusively in hospitalized patients. RESULTS During the period of the study, 481 KT recipients with COVID-19 were included in the registry: 351 fully vaccinated and 130 unvaccinated. Age, gender, KT vintage, diabetes as primary kidney disease, induction and maintenance immunosuppression and anti-COVID therapy were similar between both groups. Clinical picture was similar between fully vaccinated and unvaccinated patients: 10% versus 15.4% remained asymptomatic (P = 0.100), 56.7% versus 58.5% developed pneumonia (P = 0.720) and 66.1% versus 63.8% were hospitalized (P = 0.640), respectively. Survival analysis showed no differences between groups: 21.7% of fully vaccinated patients and 20.8% of unvaccinated died (P = 0.776). In multivariable analysis, age (HR: 1.05, CI 95% 1.03–1.08, P Regarding the type of mRNA vaccine, 213 patients were vaccinated with the mRNA-1273 vaccine (Moderna) and 161 with the BNT162b2 (Pfizer-BioNTech), showing no differences in any of baseline and treatment-related variables analyzed. Patients vaccinated with the mRNA-1273 vaccine showed a significantly lower mortality than those who received BNT162b2 (16.4% versus 28.8%, P = 0.002), maintaining this difference in the multivariable analysis (reference mRNA-1273 vaccine: HR: 0.52, CI: 95% 0.31–0.85, P = 0.010). CONCLUSION COVID-19 severity in KT patients has remained high and has not improved despite receiving two doses of an mRNA vaccine. The mRNA-1273 vaccine has shown higher clinical effectiveness than BNT162b2 in KT recipients with breakthrough infection, so it could be considered as the first option in these patients.

Background Sotrovimab is a neutralizing monoclonal antibody (mAb) that seems to remain active against recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. The evidence on its use in kidney transplant (KT) recipients, however, is limited. Methods We performed a multicenter, retrospective cohort study of 82 KT patients with SARS-CoV-2 infection {coronavirus disease 2019 [COVID-19]} treated with sotrovimab. Results Median age was 63 years. Diabetes was present in 43.9% of patients, and obesity in 32.9% of patients; 48.8% of patients had an estimated glomerular filtration rate under 30 mL/minute/1.73 m2. Additional anti–COVID-19 therapies were administered to 56 patients, especially intravenous steroids (65.9%). Sotrovimab was administered early ( Conclusions Sotrovimab had an excellent safety profile, even in high-comorbidity patients and advanced chronic kidney disease stages. Earlier administration could prevent progression to severe disease, while clinical outcomes were poor in patients treated later. Larger controlled studies enrolling KT recipients are warranted to elucidate the true efficacy of monoclonal antibody therapies.

SARS CoV2 infection has had a major impact on renal transplant patients with a high mortality in the first months of the pandemic. Intentional reduction of immunosuppressive therapy has been postulated as one of the cornerstone in the management of the infection in the absence of targeted antiviral treatment. This has been modified according to the patient`s clinical situation and its effect on renal function or anti-HLA antibodies in the medium term has not been evaluated.Evaluate the management of immunosuppressive therapy made during SARS-CoV2 infection, as well as renal function and anti-HLA antibodies in kidney transplant patients 6 months after COVID19 diagnosis.Retrospective, national multicentre, retrospective study (30 centres) of kidney transplant recipients with COVID19 from 01/02/20 to 31/12/20. Clinical variables were collected from medical records and included in an anonymised database. SPSS statistical software was used for data analysis.615 renal transplant recipients with COVID19 were included (62.6% male), with a mean age of 57.5 years.The predominant immunosuppressive treatment prior to COVID19 was triple therapy with prednisone, tacrolimus and mycophenolic acid (54.6%) followed by m-TOR inhibitor regimens (18.6%). After diagnosis of infection, mycophenolic acid was discontinued in 73.8% of patients, m-TOR inhibitor in 41.4%, tacrolimus in 10.5% and cyclosporin A in 10%. In turn, 26.9% received dexamethasone and 50.9% were started on or had their baseline prednisone dose increased.Mean creatinine before diagnosis of COVID19, at diagnosis and at 6 months was: 1.7±0.8, 2.1±1.2 and 1.8±1 mg/dl respectively (p0.001).56.9% of the patients (N=350) were monitored for anti-HLA antibodies. 94% (N=329) had no anti-HLA changes, while 6% (N=21) had positive anti-HLA antibodies. Among the patients with donor-specific antibodies post-COVID19 (N=9), 7 patients (3.1%) had one immunosuppressant discontinued (5 patients had mycophenolic acid and 2 had tacrolimus), 1 patient had both immunosuppressants discontinued (3.4%) and 1 patient had no change in immunosuppression (1.1%), these differences were not significant.The management of immunosuppressive therapy after diagnosis of COVID19 was primarily based on discontinuation of mycophenolic acid with very discrete reductions or discontinuations of calcineurin inhibitors. This immunosuppression management did not influence renal function or changes in anti-HLA antibodies 6 months after diagnosis.

Background and Aims Long-term immunosuppression in solid organ transplant (SOT) recipients could be associated with high risk of cutaneous malignancies. Any suspicious lesion should be excised and sent for pathologic examination. Method We performed a descriptive retrospective single-center study to evaluate the incidence of all skin cancer lesions in 372 kidney transplanted recipients between January 2015 to July 2020 with at least 6 months of follow-up. Results We identified 53 recipients who developed skin diseases during post transplant period. Mean age was 63y, predominantly men (62%), caucasian race, with light phototype (I-II 95%).Mean follow-up were 16 months (45% first year, 23% second year, and 32%> 3 years). 70% of the patients were over 60y with an earlier development of the lesions. Actinic keratosis was the most frequent non- excised lesion. 27 patients were biopsied (51%) in whom 66% showed malignant skin lesions (squamous cell carcinoma-SCC: 39%; Basal cell carcinoma-BCC: 50%; melanoma 11%). The most frequent immunosuppressive treatment (IS) associated between these recipients was the combination of tacrolimus (Tac) and mycophenolate (MMF; 62%) versus tacrolimus (Tac) and everolimus scheme (EVE; 38%). Up to 18.5% had multiple and mixed carcinomas. 4 to 5 patients of them were with MMF regimen. This treatment was also more frequent among patients with SCC (33%). Conclusion

Introduction:Remdesivir has demonstrated antiviral activity against coronavirus, shortening the time torecovery in adults hospitalized with moderate/severe COVID-19. Severe adverse events such as acutekidney injury have been reported. Scant data are available on the use and safety of remdesivir in kidneytransplant recipients.Methods:We present a multicenter cohort study of 51 kidney transplant recipients with COVID-19 treatedwith remdesivir. Outcomes and safety were assessed.Results:Mean age at diagnosis was 60 years, with a median time since kidney transplant of 4.5years. Mean time since admission to remdesivir was 2 days. Twenty-eight patients (54.9%) requiredmechanical ventilation (19 noninvasive). Mortality was 18.9% and markedly higher if aged$65 years(45% vs. 3.2% in younger patients). Acute kidneyinjury was present in 27.7% of patients, but wasdiagnosed in 50% before treatment. No patients required remdesivir discontinuation because ofadverse events. We did notfind significant hepatoxicity or systemicsymptoms resulting from thedrug. Conclusion:In our cohort of kidney transplant recipients, remdesivir was well tolerated and safe in renaland hepatic toxicity, but randomized trials are needed to assess its efficacy. The authors are indebted to the many physicians andnurses who take care of these patients and are facing theCOVID-19 pandemic in our country. This research wassupported by Rio Hortega contract CM19/00004 (ISCIII)(AB), and RD16/0009/0013 (ISCIII FEDER RedinRen). MJP-S is supported by a Spanish Society of Transplantscholarship

Obstructive sleep apnea (OSA) is a recognized risk factor for the development of diabetic kidney disease (DKD). Our objectives were to compare the urinary albumin–creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) of patients with DKD according to OSA severity, and to evaluate the contribution of sleep parameters to their renal function. In a multicenter, observational, cross-sectional study, 214 patients with DKD were recruited. After a sleep study, UACR and eGFR were measured, as well as serum creatinine, fasting glucose, glycated hemoglobin, insulin resistance, lipid profile and C-reactive protein. UACR was higher in severe OSA patients (920 ± 1053 mg/g) than in moderate (195 ± 232 mg/g, p 2, respectively; p

Background and Aims HEMO study showed that β2M level over time was predictive of all-cause mortality in haemodialysis patients (HD). Later studies suggested that protein-bound uremic toxins are associated with mortality in HD patients but with recent contrasting results. Aim of study was to analyse β2M and indoxyl sulfate (IS) as predictor factors of mortality. Method 5 years follow-up of 60 prevalent HD patients of our hospital. Demographic data was described. Baseline midweek pre-dialysis serum β2M was determined by nephelometry and total IS levels by high performance liquid chromatograph connected to a UV detector. We considered high serum β2M group as if was equal or higher than 27,5 mg/L. As to IS, patients were divided into quartiles (1q 26.5 mg/L). Survival curves were assessed using the Kaplan–Meier analysis at 1,2,3 and 5 years in univariate analysis for albumin (≥38 g/L or lower), β2M, and total IS groups, and evaluated by the proportional hazards Cox´s model. P -values Results 60 prevalent patients with mean vintage of 46,8 months (range 3-299 months). Mean age was 60±20 years. Males were more prevalent (53,3% vs 46,6%). 35% had diabetes. 51,6% underwent conventional hemodialysis (HD), 48,3% post-dilution haemodiafiltration, with mean convective volume of 23,8±2,8L. Mean eKt/V was 1,67±0,4, mean nPCR was 1±0,27g/kg/day. Only 8,3% of patients had urine volume>500cc/24hours. Mean β2M level was 35,6±1,9mg/L (X±SE) and mean total IS level was 18,9±1,6mg/L. The overall mortality at 5 years was 57%. Albuminemia lower than 38g/L was associated with mortality at 2, 3, and 5-years in univariate analysis (Cox´s F test p=0.03, figure 1). We found no difference in survival rate between patients with high or low serum β2M levels at 3- or 5-years analysis (Cox´s F test p=0.27). At 2 years analysis, patients in the lower β2M group had better survival (Cox´s F test p=0.04, Figure 1). There was no statistically significant association between albumin, β2M, IS level and all-cause mortality on Cox regression multivariate analysis. We observe no statistically significant association between IS levels and all-cause mortality neither on univariate, nor on multivariate analysis. Conclusion β2M < 27,5 mg/l was associated with better survival at 2 years univariate analysis. IS had no statistically significant association with all-cause mortality in our cohort.